Provider Demographics
NPI:1407121908
Name:ENGELLAU, DIANA HEARNE (RN, FNP)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:HEARNE
Last Name:ENGELLAU
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 RIVIERA CIR
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1510
Mailing Address - Country:US
Mailing Address - Phone:415-686-5044
Mailing Address - Fax:
Practice Address - Street 1:490 RIVIERA CIR
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1510
Practice Address - Country:US
Practice Address - Phone:415-686-5044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily